Why is it so hard to find a therapist?September 22, 2011 2:18 PMSubscribe

How do you find a therapist? I have been trying for months and can't find one that is accepting new patients and takes my insurance.

I have needed a therapist for years. Every six months or so I get really desperate and begin the search again. But I can't find anyone who is taking new patients now and who accepts my insurance. I call and email a few dozen people and less than a handful reply, only to tell me they can't help. (I find ones I’m interested in via PsychologyToday and a Philly therapist association that I can’t remember the name of right now.) This crushes my spirit and I give up for another six months before the crushing depression reminds me I should try to find help again.

The random list from my insurance company of people in network is not helpful. I Google these names and nothing comes up besides their address. I want to know what kind of doctor they are (psychologist; psychiatrist; social worker; etc), what their focus is, etc. before I commit to going to one. I only get 20 visits a year, and I don't want to waste them bouncing from person to person trying to find a fit.

I cannot afford to pay out of pocket for a $200/50 minutes appointment, so I have to go to someone who accepts my insurance (Keystone Health Plan East [seems like mental is handled by Magellan]).

I need someone in Center City (ish; but no main line or northeast or kofp suggestions) who is taking new patients who is on my insurance and is a decent therapist. How do I find this mythical person? What am I missing in this task that should be relatively simple and easy? Where and how should I be looking? (Friend's suggestions have not been fruitful--they are not taking new patients.)

The effort of trying is exhausting and just adds to my crisis. No one is there to help me and I have TRIED to help myself and failed miserably.

Most therapists don't take insurance. The ones that do have a solid book of business.

You can either pay out of pocket, find cheaper forms of therapy (social workers, etc.), or try some non-therapeutic methods.

If you live in Philadelphia, call up the various medical schools there and ask if they have psychiatric residents on staff. Those would be cheaper than a full psychiatrist. And they may take insurance.posted by dfriedman at 2:21 PM on September 22, 2011

Most therapists don't take insurance. However, most insurance will reimburse partial payments to out-of-network providers. Find out what your benefits are for out-of-network mental health treatment. It may bring those 3-digit hourly rates down to a more manageable out-of-pocket cost.posted by decathecting at 2:23 PM on September 22, 2011

The best way to deal with this is to find a therapist when you don't need one and start seeing them so that when you do, you will already have someone lined up.posted by TheBones at 2:23 PM on September 22, 2011 [1 favorite]

My mom is a therapist. She's on a bunch of insurance plans, and gets more work than she really can handle thought them - but she's always happy to see someone who will pay cash, and she charges them a different rate, because they're so much less work (and they actually do pay her, unlike the insurance companies a large percentage of the time.)posted by restless_nomad at 2:26 PM on September 22, 2011

Er, point being, just because someone isn't on your plan doesn't mean it's not worth inquiring if they have an out-of-pocket rate.posted by restless_nomad at 2:26 PM on September 22, 2011

Even though it's a pain in the butt to have to do it this way, you might want to call everybody on the list your insurance company provided to find out more about them and to see if they're taking patients. Seems a lot more likely you might find a fit that way than digging around on MeFi.posted by zug at 2:51 PM on September 22, 2011 [3 favorites]

Why don't you call the therapists on your insurance company's "random list" and just ask them these questions (what kind of doctor they are, what their focus is), as well as whether or not they are taking new patients? I know it sucks going to see a new doctor without any reviews to back them up, but that's the reality sometimes. An absence of web reviews really doesn't mean the people are bad at what they do.posted by Jemstar at 2:52 PM on September 22, 2011 [2 favorites]

From the OP:

I do ask folks about sliding-scale/out of pocket rates. They're generally $100-$150 per 50 minutes (their regualr rates are $200 and up). I truly cannot afford this. We're coming out of the worst 2 years of our lives. It will be a struggle to pay the $40 copay if/when I find someone.

Out of network isn't helpful right now because we have a several thousand dollar deductible before any benefits (50% of cost) kick in. If I had several thousand dollars, this would be a moot issue because I could just go to someone who didn't take insurance.

I went through this a while back. It's really hell. In fact I ended up checking myself into a mental hospital because it was the only way I could get care — which I don't recommend if you're not desperate, but it's an option.

A less drastic option — and what I ended up doing once I was out of the hospital — is to see if any of those in-network therapists have a waiting list, or have appointments open in the distant future. Even if you end up seeing someone six months or a year from now, that's better than never seeing anyone. And just knowing "Okay, if I make it through the next six months, I'll get help and this will start getting easier" makes it easier to actually make it through the next damn six months. Misery is easier to tolerate if there's a light at the end of the tunnel.

The random list from my insurance company of people in network is not helpful. I Google these names and nothing comes up besides their address. I want to know what kind of doctor they are (psychologist; psychiatrist; social worker; etc), what their focus is, etc. before I commit to going to one. I only get 20 visits a year, and I don't want to waste them bouncing from person to person trying to find a fit.

Recently, my girlfriend started seeing a therapist who did a brief (maybe 10 or 15 minutes) phone interview with her before their first proper appointment. I have no idea how common this is, but you might ask when you call around for appointments.posted by nebulawindphone at 3:20 PM on September 22, 2011

OP - I went through this too. Out of 10 calls I'd get one return call and usually they weren't accepting new patients. I did eventually find someone through a call to an eating disorder organization; they had an updated list of who was accepting patients for my issue and insurance coverage. Lots of therapists DO take insurance, I'm sure you can find one. My therapist, a clinical social worker, has recommended the National Association of Social Workers referral service. They will do the legwork for you. Try them
http://www.naswma.org/displaycommon.cfm?an=1&subarticlenbr=35

Also, I don't know if you spoke to your insurance company or just printed put the list. Often it's not updated - your insurance company should be able to help you find a therapist with a similar referral service like the one I listed above. The Psychology Today website is ok, but by no means comprehensive. Also, if you have an Employee assistance plan through work, they can help you too. Good luck!posted by Sal and Richard at 3:47 PM on September 22, 2011

Just tried a quick search on ZocDoc for psychotherapy in Center City. They say they're launching that service in a few weeks, so if you don't find anything, keep checking on ZocDoc to see if it's set up. I've found it to be really helpful in NYC - while there are a ton of providers out of network, you will hopefully be able to find someone who takes your insurance and has an open appointment. They usually have pictures uploaded and/or you can cross check with Psychology Today.

In terms of medication, most psychiatrists are out of network and will run $100-$200 per session. Luckily, you shouldn't have to see one very often, once you find a drug that works for you. You can also have your GP prescribe something, but they likely won't be as knowledgeable about your medication options.posted by melissasaurus at 3:53 PM on September 22, 2011

I do ask folks about sliding-scale/out of pocket rates. They're generally $100-$150 per 50 minutes (their regualr rates are $200 and up).

There are definitely sliding scales that slide further than this. My old therapist charged me $90 but I know she went lower than that for people in need, down to $50 I think. She even offered to see me for free when I was between jobs! She is "only" a social worker and not a psychologist but she was great.

I found her by using the online search resource from Psychology Today. I don't have the link but it's googleable.posted by drjimmy11 at 4:06 PM on September 22, 2011

I go to counseling at a center that is staffed by grad students who are getting advanced degrees in counseling/psych/social work/etc. It's on a sliding scale, and very affordable - I pay about double my hourly gross wage for a session. The only downside is that they do graduate so after a year or so you have to switch, but I have actually enjoyed having different therapists because I get different perspectives. Also some people don't want/need therapy long-term anyways.

This particular center is based out of a small private Catholic elementary school/church but the students are from Universities all over the area. FWIW I am not religious (or Christian) and I have never felt uncomfortable. I found out that the last counselor I had actually went on to be a nun, but I had no idea that she was so religious and she was just so amazing and accepting (not that there is anything wrong with religion, but perhaps strict Catholics are not usually that accepting of liberal Atheist secular Jews!).posted by radioamy at 4:34 PM on September 22, 2011

You may have to make a lot of phone calls. Go through the list, call each in-network therapist, asking
1. Are you accepting clients through _InsuranceCo_?
2. What form or therapy do you practice?
3. Have you had experience with _my form of problem_?
4. What is your degree, where is it from, when did you get it?
5. What do you charge?
6. Wild card question(s) - come up with 1 or 2 questions that will get the potential therapist talking, like Do you believe in ghosts? or Are you a feminist? or whatever. It helps if the questions are connected to things you care about. It gives you a sense of the therapist as a person.

Get on waiting lists. Keep notes. If no one is accepting patients, call the insurance company and ask for more options. Your primary doctor may be able to help you by giving you a referral, which might get you in faster.

Ask if your employer has an Employee Assistance Program (EAP). They may offer some therapy.posted by theora55 at 4:45 PM on September 22, 2011 [4 favorites]

You sound a little frantic, which I totally get in your situation. So here's a possible starting point:

Call the ones you want to know about; certainly their credentials/specialty is something they'll tell you upfront!

Question: does your employer have an EAP (Employee Assistance Program)? This is usually a 3, 6, or 9-session setup of therapy visits that are usually low cost or free. All you have to do is call them and set up an appointment with someone on the list. It's used for short-term counseling (grief, alcoholism relapses, disaster trauma) but I don't believe it's restricted to a certain kind of need; ours, at least, you can go for any reason you deem necessary.

It's not a solution, but can at least get you in to one therapist, who, if they don't fit, might be able to refer you to someone who fits you better, without using up your 20 visits.

And...maybe it's more important that you just go to someone, than that you worry overmuch about them being the "right one." You sound a little frantic; maybe talking to any competent therapist (which is most of them) would help you get started on your recovery. Don't let this fretting keep you from getting any care, which won't help you at all.posted by emjaybee at 4:51 PM on September 22, 2011

urgh sorry for telling you you sound frantic twice, bad pasting on my part.posted by emjaybee at 4:51 PM on September 22, 2011

Some therapists do short introductory phone/in person sessions for free. Make sure you ask about this, since it may help you evaluate a therapist before using any of your 20 visits.

There are many therapists who charge under $100. Insurance often pays less than that for a non-MD. E.g. United Health Care pays a PhD (psychologist) something like $84. I don't know your area so I can't be more specific, but you need to shop better.posted by Obscure Reference at 5:18 PM on September 22, 2011

Most therapists don't take insurance.

This is so not true. Also not true is that you have to pay $200 for an appointment. They have sliding scales, they have payment plans, there are *great* student therapists, and please please please accept the idea of someone with an MSW, not PhD. that's what I have and I'm very happy even though I could afford more, my insurance would pay for it and I met with PhDs. You just need someone who clicks and you have to WORK for it. Follow theora55's advice and just keep working through it. Try therapists with free consultations ( Psychology Today's Website will help you with this) and if you can't afford them or they don't take insurance, ask them what you should do.posted by sweetkid at 7:00 PM on September 22, 2011 [4 favorites]

Why do they tell you they can't help? ALL of these people can't help? The very first one I clicked on said she took a free phone consultation. Also try the email feature -- that was helpful for me. The third one had a free in person and phone consultation. Keep trying!posted by sweetkid at 7:26 PM on September 22, 2011 [1 favorite]

From recent experience (w/in 4 weeks) w/Blue Shield PPO: I called the MH customer service person who showed me how to pull up on the Blue Shield (at least in my corner of Northern California) web site and there was a long-than-I-expected list of persons accepting my (perhaps atypical?) insurance. W/google etc. I was able to review detailed web sites for several providers. Long and short, a good outcome w/regard to insurance plus [other]. I would not extrapolate from my experience, necessarily, but one should exhaust the customer service hotline in combination with web research, because if that works it's a huge savings and that's what insurance (should be don't laugh at me) is for. If people have coverage they should use it if it's possible (which it might not be) because "that's a lot of money slash it adds up over time" (cue parental memory-echo).posted by ClaudiaCenter at 10:03 PM on September 22, 2011

I also second looking for someone with a Masters of Social Work (MSW) or a Licensed Clinical Social Worker (LCSW). They will likely be on the lower end of the sliding scale. I usually paid between $60-$90 per session seeing someone with these degrees.
You might also want to try calling a crisis hotline. They can listen, and could probably give you local resources for free or low cost mental health help.
Also you can call 211 to find out what social services you can access. If money is tight, getting a food or transportation subsidy could ease stress & free up money for therapy.posted by anotherkate at 4:15 AM on September 23, 2011

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